Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Moutaz Al-Nabhan

Committee Member

Dr. Melanie Hardin-Pierce

Committee Member

Dr. Debbie Hampton

Abstract

Background: Delirium is an acute dysfunction of cognition, memory, and attention resulting in changes in perception, mood, and activity. Delirium is associated with increased length of hospital stay, prolonged mechanical ventilator days, increased mortality rate, and a higher number of discharge disposals to rehabilitation centers. The purpose of the study is to assess the current practice in delirium assessment and management strategies among postoperative patients in Intensive Care Units. Methods: A retrospective medical record review was conducted in postoperative patients admitted to Norton Women’s and Kosair Children Hospital between January 2015 and December 2015. Postoperative delirium was diagnosed in compliance with CAM- ICU screening. Variables focused on in the study included: length of hospital stay, length of ICU stay, discharge disposition to rehabilitation facilities, number of mechanical ventilator days, use of restraints, and use of pharmacological and non-pharmacological measures. Results: Of the 115 patients assessed, 65 (56.5%) were screened for delirium. Among the 115 patients, 61.5% were positive for delirium and 38.4% were negative. The median number of mechanical ventilator days and number of restraint days in delirium positive patients was 3.5 and four respectively. The length of ICU stay (p=.000) and the length of hospital stay (p=0.001) were significantly associated with delirium. Sixty percent of patients diagnosed with delirium required rehabilitation placement after the ICU stay. Thirty-seven and half percent of the patients who were positive for delirium received interventions. Conclusion: The study results demonstrated that there was a significant gap in delirium screening in the ICU. Postoperative delirium was an independent risk factor for increased number of mechanical ventilator days as well as increased use of restraints. Study results indicate the need for early identification of delirium in postoperative patients in ICU and the development of evidence-based delirium management protocol.

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